title: Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device.
abstract: OBJECTIVE
  To determine if an apparent increase in bloodstream infections (BSIs) in patients with central venous catheters (CVCs) was associated with the implementation of a needleless access device.
  
  
  METHODS
  Retrospective cohort study using a derived CVC-days factor for estimating appropriate denominator data.
  
  
  METHODS
  A 350-bed urban, acute, tertiary-care hospital.
  
  
  METHODS
  BSI surveillance data were obtained, and high-risk areas for BSIs were determined. A random 5% sample of medical records was used to estimate CVC days, and a cohort study was conducted to compare BSI rates before and during needleless device use. A survey was conducted of nursing needleless-device practices.
  
  
  RESULTS
  The surgical intensive-care unit (SICU), the medical intensive-care unit, and the solid organ transplant unit (OTU) were identified as high-risk units. Using existing surveillance BSI data and the estimated CVC days, the catheter-related BSI rates in the high-risk surgical patients were significantly higher during the needleless-device period compared with the preneedleless-device period (SICU, 9.4 vs 5.0/1,000 CVC days; OTU, 13.6 vs 2.2/1,000 CVC days). A survey of the nurses revealed that 60% to 70% were maintaining the needleless devices correctly.
  
  
  CONCLUSIONS
  We observed a significant increase in the BSI rate in two surgical units, SICU and OTU, associated with introduction of a needleless device. This increase occurred shortly after the needleless device was implemented and was associated with nurses' unfamiliarity with the device, and needless-device use and care practices different from the manufacturer's recommendations.
authors.affiliation: Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
authors.forename: S T
authors.initials: ST
authors.lastname: Cookson
authors.forename: M
authors.initials: M
authors.lastname: Ihrig
authors.forename: E M
authors.initials: EM
authors.lastname: O'Mara
authors.forename: M
authors.initials: M
authors.lastname: Denny
authors.forename: H
authors.initials: H
authors.lastname: Volk
authors.forename: S N
authors.initials: SN
authors.lastname: Banerjee
authors.forename: A I
authors.initials: AI
authors.lastname: Hartstein
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D002405:Catheterization, Central Venous; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D004869:Equipment Safety; D006745:Hospital Bed Capacity, 300 to 499; D006801:Humans; D015994:Incidence; D009339:Needles / Q000009:adverse effects* / Q000706:statistics & numerical data; D009741:Nursing Staff, Hospital; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology*; D014481:United States / Q000453:epidemiology